Private Investigator Agency/ Principal License - Business Licensing ...

Federal Bureau of Investigation Privacy Act StatementAuthority: The FBI’s acquisition, preservation, and exchange of information requested by this form is generally authorizedunder 28 USC 534. Depending on the nature of your application, supplemental authorities include numerous federalstatutes, hundreds of state statutes pursuant to Public Law 92-544, presidential executive orders, regulations and/ororders of the Attorney General of the United States, or other authorized authorities. Examples include, but are not limitedto: 5 USC 9101; Pub.L. 94-29; Pub.L. 101-64; and Executive Orders 10450 and 12968. Providing the requested informationis voluntary; however, failure to furnish the information may affect timely completion or approval of your application.Social Security Account Number (SSAN): Your SSAN is needed to keep records accurate because other people mayhave the same name and birth date. Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency isresponsible for informing you whether disclosure is mandatory or voluntary, by what statutory or other authority your SSANis solicited, and what uses will be made of it. Executive Order 9397 also asks federal agencies to use this number to helpidentify individuals in agency records.Principal purpose: Certain determinations, such as employment, security, licensing, and adoption, may be predicated onfingerprint-based checks. Your fingerprints and other information contained on (and along with) this form may be submittedto the requesting agency, the agency conducting the application investigation, and/or FBI for the purpose of comparingthe submitted information to available records in order to identify other information that may be pertinent to the application.During the processing of this application, and for as long hereafter as may be relevant to the activity for which thisapplication is being submitted, the FBI may disclose any potentially pertinent information to the requesting agency and/or to the agency conducting the investigation. The FBI may also retain the submitted information in the FBI’s permanentcollection of fingerprints and related information, where it will be subject to comparisons against other submissionsreceived by the FBI. Depending on the nature of your application, the requesting agency and/or the agency conductingthe application investigation may also retain fingerprints and other submitted information for other authorized purposes ofsuch agency (ies).Routine uses: The fingerprints and information reported on this form may be disclosed pursuant to your consent, andmay also be disclosed by the FBI without your consent as permitted by the Federal Privacy Act of 1974 (5 USC 552a(b))and all applicable routine uses as may be published at any time in the Federal Register, including routine uses for theFBI fingerprint Identification Records System (Justice/FBI-009) and the FBI’s Blanket Routine Uses (Justice/FBI-BRU).Routine uses include, but are not limited to, disclosures to: appropriate governmental authorities responsible for civil orcriminal law enforcement, counterintelligence, national security or public safety matters to which the information may berelevant; to state and local governmental agencies and nongovernmental entities for application processing as authorizedby federal and state legislation, executive order, or regulation, including employment, security, licensing and adoptionchecks; and as otherwise authorized by law, treaty, executive order, regulation, or other lawful authority. If other agenciesare involved in processing this application, they may have additional routine uses.Additional information: The requesting agency and/or the agency conducting the application/investigation will provideyou additional information pertinent to the specific circumstances of this application, which may include identification ofother authorities, purposes, uses, and consequences of not providing requested information. In addition, any such agencyin the Federal Executive Branch has also published notice in the Federal Register describing any system(s) of records inwhich that agency may also maintain your records, including the authorities, purposes, and routine uses for the system(s).BLS-700-320 (4/22/13)Page 5 of 6